Xerox System Helps Hospitals Better Predict Readmissions

Midas+, a subsidiary of Connecticut-based Xerox, is combining its vast data resources with five years of Medicare and claims data to help hospitals better predict readmissions. With this new system, known as Midas+ Readmission Penalty Forecaster, a hospital can get a much more accurate prediction or “near real-time” information on both patient patterns and reimbursement rates.

The Forecaster solution uses advanced analytics and expert consultation to deliver predictive insights, providing estimates for a hospital's expected financial penalties for two and three fiscal years into the future.

The Forecaster has a 1.5 percent margin of error within the predictive model, and quarterly updates are provided to the hospitals, according to Justin Lanning, senior vice president and managing director of Xerox Healthcare Provider Solutions.

The U.S. Centers for Medicare and Medicaid Services (CMS) now penalises hospitals for excess readmissions with up to a three percent payment reduction. While CMS issues annual reports indicating whether a hospital has an excessive rate, these reports are provided nearly three years in retrospect to the risk model period. Hospitals require more near-time measurement to change the course and reduce financial impact for future years.

“Hospitals have just until June 30, 2015 to effectively improve readmission performance for fiscal year 2017 penalties,” said Alycia James, vice president of care performance transformation group for Xerox. “We can tell them today where they’re going to stand.” Several of the company’s hospitals clients are already receiving their first quarterly reports, she added.

The Forecaster’s measurements include patients who are readmitted within 30 days to a different hospital. “This isn’t a crystal ball, but the Forecaster can help hospitals get a good look at the future, and do it with enough time to make a change if needed,” Lanning said.

Midas+ also will provide on-site consultation for hospitals to respond to areas of concern and implement targeted improvement strategies, he said. “Just delivering analytics isn’t enough.”

Midas+ Readmission Penalty Forecaster is unique in several respects, Lanning said, noting that one such respect is that it is patient-focused versus provider-focused. “We took our machine-learning system and we flipped it on its head,” he said.

Traditionally, Xerox and other vendors would design a system that looks at provider benchmarks and other provider-focused concerns. That is still possible, but with a stronger focus on the patient, hospitals will be in a better position to curb readmissions or perhaps learn if a patient ends up at another hospital.

Given Xerox’s experience in healthcare and data – ranging from government health, commercial payer groups, pharmaceutical and life sciences – the company is in a good position to offer vast resources and knowledge. With some 1,900 hospital clients, combined with the Medicare data, the pool of data is large-scale and advantageous, Lanning said.

Having the large data set is a key component, the Xerox executive said, noting that excellent algorithms can be built, but if what they are analysing does not contain enough information, then they are limited in what they can achieve.

“From a data use stand point, what we have is the brain knowledge – what we can do is learn lessons,” he said.

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algorithms, medicare, analytics, readmissions, Xerox, machine learning
Midas+, a subsidiary of Connecticut-based Xerox, is combining its vast data resources with five years of Medicare and claims data to help hospitals better